1. Impact of Victoria's first dedicated endocrine hypertension service on the pattern of primary aldosteronism diagnoses
- Author
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Morag J. Young, Yin Yu Lim, Peter J. Fuller, Jimmy Shen, Jun Yang, and Renata Libianto
- Subjects
Pediatrics ,medicine.medical_specialty ,Primary Health Care ,business.industry ,MEDLINE ,Blood Pressure ,Missed diagnosis ,Primary care ,030204 cardiovascular system & hematology ,medicine.disease ,Hyperaldosteronism ,Endocrine hypertension ,03 medical and health sciences ,0302 clinical medicine ,Blood pressure ,Primary aldosteronism ,Hypertension ,Internal Medicine ,Humans ,Medicine ,030212 general & internal medicine ,Medical diagnosis ,business ,Antihypertensive Agents - Abstract
Background Primary aldosteronism (PA) accounts for 3.2-12.7% of hypertension in primary care but is often diagnosed late, if at all. A delayed or missed diagnosis leads to poor blood pressure control and greater cardiovascular risk. Aims To analyse the impact of Victoria's first dedicated Endocrine Hypertension Service on the pattern of PA diagnosis. Methods Socio-demographic and clinical data from all patients who attended the Endocrine Hypertension Service since July 2016 (N=267) was collected prospectively. Patients were divided into Year 1 (Y1), Year 2 (Y2), and Year 3 (Y3), based on their first visit. Results The proportion of primary care referrals increased (20% in Y1, 47% in Y2, 52% in Y3) with more referrals being made for treatment-naive hypertension (3% in Y1, 14% in Y2, 19% in Y3). Amongst PA patients, the median duration of hypertension prior to their first visit decreased (11 years in Y1, 10 years in Y2, 7 years in Y3), and the prevalence of end-organ damage decreased (44% in Y1, 42% in Y2, 33% in Y3). Targeted management of PA improved clinical and biochemical outcomes. The average blood pressure reduction following targeted management increased from 16/12mmHg in Y1 to 23/12mmHg in Y3. Conclusion The Endocrine Hypertension Service, with its strong component of general practitioner engagement, led to increased primary care referrals and PA detection earlier in the course of hypertension. Referred patients were on fewer antihypertensives and had less end-organ damage which simplified the diagnostic process, allowing targeted treatment to be commenced earlier and patient outcomes optimised. This article is protected by copyright. All rights reserved.
- Published
- 2021